PASSED CPNE in Utica NY 11/18-20/11

[emijen2girls]

This is my journal for CPNE 11/18-20/11 in Utica, NY

I never understood it when people would write that it is therapeutic to write a journal. When I first passed i thought "I never want to think about it" but truth to be told I have been thinking about it for so long, it has been a part of our lives for months.

I wanted to tell a little about me and my preparations; I have been an LPN for 16 years. I have been blessed with jobs in acute care setting, long term setting and also assisted living and home health. My current job is in a very busy surgical floor. most of our patients are post op of GI, GU, GYN. I usually have 4-6 patients at a time, usually with only one aide, and most days end up with total for the day of 8 patients. i know how to give good care and prioritize. I am telling you that because that is not the reason I passed, it is the reason I failed my first PCS.....but that will be later.

I read the manual a total of 4 times. after I printed it I placed it in 4 different binder (care plans+eval phase, AOC, Sim Lab, append). I didn't pay too much attention to the skills lab until the last month as I do those all the time (i knew that I just need to nail the critical elements for those...so I started gathering the supplies).

I got my mnemonics and wrote them on flesh card, I had a set at home and at work. I wrote them and re-wrote them until you could have woken my up at gun point (which is hoe the CPNE felt like) at 3am and I could tell you what they stand for.

Now, the mnemonics were not mine so I made sure to go through the check off list the CE will have for all of them and made sure I had everything.

Once I mastered the critical elements I practiced the AOC on my girls (teens) but only once since I do this all the time.Now if you are an LPN that works in a doctor office or nursing home you might want to work on approaching pts. All my CE told me that they can see that I give good care. I think that they want to see you comfortable because after this you are sent out to the world and their reputation is on the line.

I also read every journal on the EPN boards all the way back to MAY 2011. I read all of the staff answers on the boards (Nona and also Civita) and I emailed both care plans and questions to EC all the time. You can even re-submit a care plan which I did. I got a weekly phone call every week the last 3 weeks (call and book thos in advance, they get pretty busy) the last one was on Thursday at 2pm.

I also found another student that was testing the same weekend as I but in another location. I couldn't afford to fly anywhere and pay for on site workshop so I drove to her house (300 miles), brought my 2 teen girls as patients to practice on and we spend 5 days talking about the CPNE... we also did something that really helped me: we highlighted all of the 20 NANDA most used (from the EC manual) and other ones that sounded reasonable...we then highlighted interventions we might use (so many interventions are assessments and stuff for home that it really cut on time when looking for interventions during the CPNE). That really paid off in my last PCS where I just couldn't think of an intervention.

I didn't want to tell friends/family and co-workers...it was stressful enough without people saying..."is it next week?" but my girls told one of my friends so I used her to check off my lab skills. I had her hold the same form as the CE would.

I printed the whole packet (kardex/care plan/revised/evaluation/PCS response form/narratives)and made something like 15 copies. I practiced filling them out completely....I wrote my mnemonics on the kardex and charted on about half of the areas every other day. By the time they gave me the forms at the actual CPNE those forms were very familiar to me.

other things I did: I booked an early flight because I wanted to adjust to the time difference of 3 hrs. i also got a massage the night before I left (contact a massage school, it was $20 for an hour massage). I was very nervous about renting a car and driving on roads I have never seen before. That was a valid fear as I got lost 3 times on my way there and twice on the way back.....

So I got to the Holiday Inn in Utica, NY Tuesday evening. They have an on site restaurant which is the only place I ate the whole time (did I already mention i get lost easily?).

I brought with me all the lab supply (mailed syringes and needles to the hotel since I did not know if the airline will let me take it) and the appendix that has all the check offs for lab and AOC. it was my comfort zone. I ended up not practicing the labs but it was better than wanting to and not having it.

I made a run to the hospital on Thursday to see where it was (0.3miles from hotel...got lost on way there and back)....we were going to meet in the Lobby and the gift shop is right there. I saw a fridge magnet that said: "congratulations, today is your special day", I vowed to purchase it if I pass.

Friday started the same way everyone, there were 6 of us: myself, one guy who took the EC workshop and had grid and mnemonics, one lady was a paramedic, it was her second try she said that she hasn't even studied in the last 2 month since it was all 'basic nursing stuff', another was an LPN who worked in LTC, one LPN who was pretty much fresh out of school but was confident she didn't need to have mnemonics because she was so fresh out of school (i know I had to overcome all my bad habits so there is something to that), and the last one was a young lady who needed just one more semester of nursing school to get her RN, she was working in a doctor office.

the CA came to pick us up, she was smiling and pleasant. we did all the paper work and started with the lab.

I had secondary IVPB first: calculated my drops/min and it was 37. regulated my drops and nailed it on the first try...or so I thought....after checking 2 sets of 15 seconds I counted for 1 min and it slowed down so much. I fiddled with it until I got it with 5 min to spare. PASS

next was wound, the wound in Utica is the same size but shallow (by the way, I found that out from a lady that tested there back in July, I found her on facebook and contacted her, she played an important role in my success as she talked to me and calmed me down a few times), I packed that wound during practice and no one has touched it since so I re-packed it....now here is what happened: since there is nothing to write your start/stop time on at the wound station I chose to set my own watch to 12:00 and start it when the CE said 'start' and know I have until 12:15. So i did my packing and I was almost sure that the gauze touched the wound...on the CE side so I looked to see how much time i had and almost fainted! I didn't push the button back in hard enough so it was still saying 12:00. I decided in that second that I am not repacking. I threw the 4x4 on it, abd and tape...PASS.

next was IM shot...I practiced at home on oranges (at work I rarely give IM and when I do I use the deltoid) and once in a while place my hands on my girls' thigh. when their leg/thigh was way smaller. Now, I can't stress how much knowing your critical elements are....I was so stressed out that I started writing the critical elements for IV push....caught myself and wrote the correct one. As soon as I got my 1 inch needle in that thigh the CE says 'stop' calls the CA and says 'placement' I said 'it is in the muscle' the CA says 'it should be a little more to the out side' I say 'it is in a muscle' the CA says 'it is in all the way to the hub, what needle did she use?' I say '1 inch' she says 'and it should be 1.5 inch in the thigh' and I say 'no, I clarified it on the boards with faculty' she says 'ok, it is a pass'. What I didn't mention before is that this new guidelines are new for them too and the CA said to us, 'if you know what you are doing you should defend yourself'.

next, after a long wait, came the one I dreaded the most the IVP, I had a hard time at home getting rid of my bubbles and finishing under 15 min. God had mercy on me, I had 1ml over 30 seconds, such a short time I never practiced anything under 1 min. I shook a little on the last draw but gave it over 40 second with 1 min to spare. PASS

went to get my first pt.: this lady had gastric bypass today, she was 399lb and needed a bolus of NS for low b/p, she was getting pain control. I was told 'foley' but read that she ambulated to the bathroom already for void....so I was added output. I had abdominal assessment, Pain management, ambulate x1 with assist. I really think that was it.

Went to the hotel crazy happy for passing all labs. That was my prayer request for that day...

I chose for my Nandas: acute pain, was going to offer back rub and to watch Tv and 3rd not on care plan request primary to medicate. I also chose activity intolerance because my floor is the designated bariatric surgery floor and most of my pts are in a lot of pain and have hard time amb the first day post op. I chose for interventions that i will enc her to dangle at side of bed and rest between activities.

came in Saturday morning. handed my care plan after my time started and my grid was written. It took my CE a little time to come back...I was worried because in report I was told that she amb ind in room. but my goal was for her to verbalized increase in tolerance of amb and I was going to take her for a walk in the hallway.

It was fine. Got in the room, pt pleasant, denies pain. abd assessment, she is hypo bowel tones, no palpation doesn't hurt she is motivated to do her share and doesn't need any assist to amb. I was getting a little worried in the back of my mind of what her priority Nanda will be but first I needed to get vitals since I had 9am meds and one was Lopressor with parameters of 'hold if systolic 100 or less' no her systolics has been running 98-137 so i took it and it was 108. I waited a little and here comes my mistake: at work in that situation I would hold the med...just too close to comfort...I would watch her and retake in an hour or 2..so I decided to re-take even though I heard it perfectly. now the first time I pumped it to the high 150s about 20 over her highest, this time I just wanted to make sure it is well over 100 so I pumped it to 120, heard it at 118 and declared....out of the room, waited for what seemed eternity. the CA came in and said that the second time I didn't pump high enough and the CE even went back and checked and it was 137...FAIL.

I shook it off and regrouped....I had another adult so Indeed it to stay in the game. I took my 20 min break in the cafeteria. The paramedic lady was there...I set with her (big mistake), she never got in pt room, she used assessment for intervention and failed planning phase (she is the one that said she didn't crack her books in 2 months). She was saying how they nit pick and I thought 'well, it is their test, no one is forcing us to do it. There is a reason why they are the only distance learning school approved by most states in the US'.

Went back for my second adult. nice gentleman, in with acute back pain with unknown origin, on O2, IV fluids.

resp assessment with sats, Pain management, O2 management, skin assessment. reposition in bed (not on bed rest but this was my assignment), regular diet, I&O.

NAnda: acute pain (offer back rub and to watch TV), impaired gas exchange (maintain O2 at 4lpm via NC, reposition up - since i was assigned to reposition in bed and it is a critical element in O2 management).

I did all my assessments and my vitals, measured I&O......and it was time to declare my vitals...I did and the CE said 'lets leave the room', she sat me down and said I need to call the CA. I didn't know what went wrong, I just knew I failed...I was done, this is my second adult and I lost almost $4000 not to mention all that I spend on the other tests that got me here. I knew that I couldn't take this stress and come one more time. I just couldn't believe how stressed I was. we waited for over 30 min. The CE was feeling terrible for me, you could just tell, she said that the radial pulse was inaccurate and that the CA will come and take it with me at the same time. This guy's base line was in the high 90s and i got 59. I felt it slow and steady and was not even worried about it. His pain was under control and with O2 his sats were at 96% so I figured that his pulse was higher at admission since he was SOB and in pain. Just when I was ready to scream from stress the CA came over. I asked if I could do the other hand and she said 'it is you PCS' so I took it again and got 58...my heart fell, I thought 'I am done' the CA asked for my number I told her and she gave me thumbs up and said

'you are good, I got 59' OMG!

So my CE said 'OK, let's go in and wrap this. I gave him his back rub and offered TV, he didn't want to watch. I told my CE that I would like to revise my care plans, we went out and I changed it to 'risk for acute pain' (he rated pain at 2-3 at first, refused pain meds offered by his primary and after back rub and reposition he rated his pain at 1-2) and also for my other intervention 'encourage pt to interact with visiting daughter' it was accepted and I went into the room, emptied his urinal, measured left over coffee and got out. My CE said, now chart everything....I did...used every minute (got 15 min back for the wait)...PASS

I went to the hotel and was just emotionally done. I called my husband and said, I just can't do it...it is too stressful and he said, you can stay LPN, he really never cared. I also called 2 other friends to pray with me, one did the CPNE and one is my best friend...I also texted the people that knew I was testing and had them pray for me....I read my Bible......I forgot to mention that I printed Bible versus for encouragement and hung them all over the hotel room walls....I cried too....a lot!

I prayed and asked God to give me strength, I knew I am facing at least 2 PCS in the a.m. one was my ped and one was my adult make up....I could even fail the ped and make that one up....I just prayed for emotional strength.

I actually got 4 solid hours of sleep that night, woke up in the morning and said " God, I will be focused for as many PCS as I need to do.

God to the hospital...I was afraid of sitting with the other student for fear of negative remarks...but did not want to appear rude...and God blessed me. First of, there was now only 4 of us. The paramedic lady and the one that was LPN and worked in LTC were gone, I am assuming they had to repeat a lab and didn't make it. All of us had to make up a PCS, 2 of the other ones told me they failed during Resp. Management: 1) before she re-assessed the lungs she asked the pt if they were comfortable, since she had comfort management it was assumed that she has started a new management and it is a fail 2) another PCS was stopped because he had teaching with resp management and started teaching before re-assessing. This info was going to help me pass mine...just didn't know it yet...

the first PCs was less dramatic than the 2 before....nice pt (ped sub), had to wait while he complained to charge nurse but was given the time back...had to do resp 3 times since the aide came in the middle and started doing stuff. I passed this one.

i was done and given my 20 min break, because I got extra time for this one there were no other student to be seen...I went to the cafeteria and it was pretty much empty...I was too nervous to eat or drink...I just walked around and sang praise songs...that was all i could think of.

My last PCS was a sweet lady that was so so tired by the time I came to mess with her but she was compliant bless her heart. I had resp management, with teaching, abd assessment (no palpation),pain scale 0-10 and transfer to chair with assist of 2.

nandas were; ineffective airways (I was told she had crackles in bases but she was only dim for me) (intervention:enc DB&C, enc use of IS x5 - I was assigned all of those). and here I didn't know what to write...for my first guy that day I had this one and since they both had abd surgery for him I chose impaired tissue perfusion - gastrointestinal but was told she already had 2 BM that morning...thanks God I highlighted NANDAs and interventions because I suddenly saw "impaired transfer ability" so I chose it. for assessment to validate I wrote simply 'will observe pt's transfer' goal" pt will transfer to chair successfully (was assigned to do it anyway) interventions: provide pt with walker for transfer (was assigned it) and encourage pt to have non skid socks/shoes at all times while out of bed. it took the CE 30 second to OK it. I ended up ambulating this lady out of the room, and putting her on a BSC twice, she was sweet....I did the teaching before I started my management and asked her if she feels ready to learn....and asked her to tell me how often she will use the IS at home and why it was important....got out of there with 1 hr and 15 min to chart.....I charted for the full hour...I mentioned every breath she took. I described in detail every move she made every time she got out of bed. i think I wrote a book......I gave it to the CE and the whole time she looked it over I prayed 'mercy, mercy, mercy..." that was all I could think. My poor kids have been hearing the word 'school' and 'CPNE' way too much. I have been doing one class at a time the last 4 years and I needed to be done.

The CE turned around and said 'you passed' i got up and said 'OK' she came and gave me a hug and said 'you did a good job'....I didn't cry, I was in shock....we went downstairs where the CA waited for us. I was the last one...I found out later that only me and the guy passed, we were the only ones that did a workshop and had mnemonics....I got my letter and left. Went to the gift shop and got my magnet!

I got in the car and drove away, I had a 2 hr drive to Albany and didn't want to waste any time. Stopped ata rest stop and asked a complete stranger to take a pic of me holding my certificate wearing white. She did and I changed and drove off.

that's my story. i give all glory and praise to my Lord, Jesus Christ and thank all my friends here on the boards that prayed for me and encouraged me. Saturday was indeed a dark day. this test is not for wimps, it tells you what you are made up from....it was not easy to come back Sunday but By His Power I did.

If you have any questions feel free to email me: [email protected]

Tali

[BeachieRN84]

Tali, You should be so proud of yourself. I agree this test truly makes you pull out what you're made of. Way to go, you studied so hard, and you earned it! Congratulations!!!!! :-)

[Lunah, MSN, RN]

Tali, I knew you could do it!!! Congrats!! :)

[emijen2girls]

Thank you Beachnurse84 and LunahRN......LunahRN, I owe you my IVP lab.....!

[BeachCathyRN]

:ancong!: and thank you for posting your journal - it really helps those of us about to go through this.

[camartinez]

congrats, what made you decide to select Utica NY, for your CPNE

[emijen2girls]

camartinez, I didn't choose Utica really just the region without specific preference to a site. I figured that no specific site has greater chance of passing (think of it this way, if normally sites have 63% pass and one had 85%, you know they will investigate and see if they let student slide). It took me a long time to come up with the CPNE money and I was flying somewhere (I am in Idaho) so I just wanted to expedite it. I faxed the CPNE app 8/11/11 and got my date on 8/19/11 for 11/18/11 so I had 3 month to study. During that time I worked 4 12hr shifts in a row and was off 10 days (2 week cycle). All I did was study.

[t-lo]

WTG Tali!!!!

[BostonNurse2876]

GOOD NEWS Tali!!!! Hope I have a positive story to tell when I return from my CPNE!!

[emijen2girls]

BostonNurse, when are you going?

[BostonNurse2876]

Tali, No clue, but this year---I have 2 more exams plus the FCCA to take. But I'm just a planner, so I like to be prepared. I keep getting down because I have heard more than a few horror stories out there of people who studied their butts off then failed. I just hope I am not one of them. What is the pass/fail rate at EC anyways??? Now that I know I'll be at least prepping for the CPNE this year, I'm starting to get a little nervous. I think I'll be OK as long as I slow down, and just focus, not letting my nerves get to me. I HOPE that will be enough--and obviously studying. Can you bring the mneumonics into the room with you?????

[emijen2girls]

BostonNurse2876, in regards to bringing to mnemonics into the room with you...yes! and you can look at them as often as you want. I told my patient that I want to give them excellent care and do not want to forget anything so I will be looking at my page (actually a packet) often. They do not care, they know you are a student.

Tali